# Minimal Change Disease: Podocyte Injury With Major Consequences

Failure to respond as expected should prompt review of diagnosis, adherence, secondary causes, and whether additional pathology is present.

![Infographic: Minimal Change Disease: Podocyte Injury With Major Consequences](https://urinenephrology.org/visual-reference/images/mastery-mcd.png?v=20261003c)

## A normal-looking light microscope is not enough

Adult minimal change disease is usually established by kidney biopsy: light microscopy may show little change, while electron microscopy demonstrates podocyte foot-process effacement. Consider FSGS sampling limitations and secondary drug or malignancy associations when the course is atypical.

## Recognize the syndrome

Edema, hypoalbuminemia, proteinuria, and sometimes AKI dominate presentation. Adults may need evaluation for drugs, malignancy, and other secondary associations.

## Assess complications

Volume imbalance, thrombosis, infection, and medication effects can be consequential. A low serum albumin is not a complete measure of intravascular volume.

## Individualize treatment

Disease-specific immunosuppression and supportive care depend on patient context and specialist assessment. Follow response and treatment toxicity together.

## Use the relapse pattern to change the discussion

Document complete versus partial remission, relapse timing, and glucocorticoid exposure. Frequent relapse or steroid dependence can justify a steroid-sparing discussion. Persistent nephrotic proteinuria despite an adequate treatment course requires review of adherence, secondary causes, and whether the diagnosis should be revisited.

## Revisit unexpected courses

Failure to respond as expected should prompt review of diagnosis, adherence, secondary causes, and whether additional pathology is present.

## Source lessons

- [minimal change disease](https://urinenephrology.org/mastery/glomerular/minimal-change-disease.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.